2.
110 L. HAUGAN ET AL.environment, focusing on learning via practical challenges and experiences. Onthese farms, there is always useful work to be done, independent of the users’varying health conditions or motivation. On these farms, it is possible to experienceclassroom theory through practical work. A recurrent theme of many Green Care programmes is the social training andinteraction, as well as the sense of belonging experienced among the programmeparticipants. For example, it is common to arrange one or several joint meals eachday, gathering everyone on the farm. Farms can be used to host a wide range of activities, such as kindergartens, after-school programmes, school projects and theme assignments, education adapted topupils with special needs, activities and tasks designed for psychiatric patients,mentally impaired and elderly with dementia. Green Care farms can also assistchild-welfare authorities, e.g., by acting as day-care centres or foster homes. Each new initiative is designed according to the needs of the users, and inaccordance with public priorities and the farm’s and farmer’s resources andpotential. The quality of the provided services depends on successful cooperationbetween the farm and the municipality and society in general. Green Care servicesare intended to have a ‘win-win’ effect, in which all parties benefit from theprogrammes. Green Care shall increase the well-being of its users, provide betterservices to its clients (local governments) by improving the utilization of availableresources and secure increased income for the farmer. By now, numerous experiences of how to establish satisfactory Green Careservices have been documented. Many of these are presented on the websitewww.innpaatunet.no, as case studies and guidelines for farmers and public-serviceexperts. BACKGROUNDAgriculture in NorwayNorway is the northernmost country in Europe. The distance from the country’snorthern to its southern tip is as great as the distance between Oslo and Rome. Dueto significant climatic variations, farming conditions vary considerably within thecountry, e.g., between North and South. Whereas vegetables and fruit are primarilygrown in southern Norway, livestock farming is most common in the North, i.e.,sheep, cattle and reindeer husbandry. In the past 30 years, Norwegian farm policieshave ‘channelled’ most of the ruminant livestock to areas that are not suited forgrain or vegetable production, i.e., northern and western Norway and othermountainous areas. Only 3% of Norway’s total land area is cultivated land (approximately 1 millionhectares), and 22% is covered by forests. The remaining area is mainlymountainous, much of which is above the tree line. In addition to producing safe,high-quality food, Norwegian agriculture also contributes to maintaining the ruralpopulation and business activities throughout the entire country. Farming activitieshelp to maintain viable rural communities. Norwegian farm subsidies vary between

3.
NORWAY 111different parts of the country, depending on the natural conditions. The aim is tocompensate for poor competitive conditions, thus enabling the continuation offarming activities and settlement in all parts of the country.Recent developmentsIn the past decades, Norwegian agriculture has gone through a rapid developmenttowards increasingly fewer and more efficient farm enterprises. In spite of thisdevelopment, the total farmland area has not decreased. The number of farms inNorway has been more than halved in the past 25 years. In a European context,Norwegian farms are small, with an average of less than 20 ha cultivated land.Average herd sizes on livestock farms are 17 dairy cows, 40 breeding sows and 50winter-fed sheep. Most farms also have forest land, and a large share of the timberharvest is carried out by contractors with modern machinery. However, wood iswidely used as a source of fuel in the long, cold Norwegian winters, and much of thefirewood is still prepared manually. Presently, there are about 55,000 farm enterprises in Norway. However, there aremore than 150,000 properties that are classified as farm estates. Total employmentin agriculture is about 70,000 man-years, or about 2.8% of the country’s total workforce. Many farms are run part-time, implying that a certain share of the total farm-family income is derived from off-farm employment. In 2002, off-farm employmentwas the main occupation for more than 40% of the part-time farmers.Norwegian agriculture well suited for Green CareWithin such a farm structure, many farmers are trying to utilize all of a farm’sresources, and not only for traditional agricultural production. Empty buildings andidle machinery can come to other uses than originally intended for. Many farmcouples would like to earn as much of their income as possible on the farm, but thisis often impossible to achieve from traditional farming activities alone. Certain aspects of Norwegian agriculture make it relatively easy for outsiders totake part in farm operations, without the feeling of being on a large-scale farm‘factory’. These aspects include their small size and wide range of products,relatively small machinery as well as a number of operations still being conductedmanually. Health and welfare services in Norway have changed in recent years – fromfocusing on centralized institutions to providing services in the users’ localcommunities. Other important guidelines are individual adaptation and a broadrange of services. The concept of Green Care complies well with this trend.Public responsibility for welfareNorway is divided into three administrative levels: the state, counties (‘fylke’ inNorwegian) and municipalities. There are 19 counties and 434 municipalities. Thelatter are responsible for, among other things, kindergartens, elementary schools and

4.
112 L. HAUGAN ET AL.care services. The municipalities are also in charge of primary services in the healthand welfare sector. The county authorities are responsible for such services assecondary education and local/regional public transport. Specialist health servicesare run by the state, and are organized as five regional enterprises. There are significant differences between municipalities with regard to theirgeography, area and population. More than half of the municipalities have less than5000 inhabitants, and 12 have a population exceeding 50,000. This makes it difficultto discuss a ‘typical’ Norwegian municipality. Municipal and county activities are of great importance for the welfare ofindividual citizens. These two administrative levels account for about 60 percent ofthe public services presently provided in Norway. As a result, most of the servicesprovided in the educational, health and welfare sector have been operated by thestate, and few such services have so far been outsourced. For Green Care, this implies that in most cases the municipality or the countywould be the buyer of a specific service. In other words, each farmer must enter intoan agreement with either of the two authorities. ORGANIZATION AND QUALITY ASSURANCEGeneral organizationGreen Care requires extensive cooperation between several ministries. At a nationallevel, an inter-ministerial committee has been established, which is chaired by theMinistry of Agriculture. The committee also has representatives from the followingministries: Education and Research; Social Affairs; Health, Children and FamilyAffairs; and Local Government and Regional Development. An important issue for the county departments of agriculture is businessdevelopment. The county departments have thus urged the local governments toconsider agriculture a new arena for developing measures in the educational, healthand welfare sector. Furthermore, the county administrations have also helped todevelop quality-assurance tools for the cooperation between farmers andmunicipalities, and provided capacity-building activities such as courses andprofessional seminars.Cooperation between farmers and the local and county governmentsThe municipality is usually responsible for assuring the professional quality of theprovided service. It is thus important to prepare new initiatives thoroughly, and tomake sure one finds a suitable farm(er). Before any farm service can be defined asGreen Care, a written agreement must be made between the farmer and the buyer ofthe services. The agreement shall address such issues as guidelines for contents,quality requirements, division of responsibilities and designation of variousfunctions (supervisor, assistant, teacher, manager, etc.), cooperation routines,financial aspects and the agreement’s validity period. Financial aspects are to

5.
NORWAY 113include such items as agreed compensation for working hours (wages), rent andreimbursement of expenses.Quality assurance of the provided serviceSo far, there are no specific quality standards for Green Care services. The buyer ofthe services is responsible for assuring the quality of the services. The generalquality assurance guidelines must be specified in each agreement, including suchaspects as organization, professional responsibility, counselling routines, routinesfor admission of new users, reporting systems and evaluation routines. Themanagement of the service in question must thereafter develop the design, routinesand measures necessary to secure the service’s professional quality. The on-farm professionalism and quality assurance must lie in the routineslinked to the day-to-day interaction with the users, and include the right of access byall relevant parties. Farmers shall not act as social educators, teachers, social workers etc., unlessthey have the necessary professional background. A Green Care farmer shallprimarily act as supervisor and supporter, while the experts purchasing the farmer’sservices are responsible for assuring the professional quality of the training orwelfare services provided to the pupils/users. However, the quality of the services,as experienced by the individual user, is highly dependent on the farmer’scommitment, understanding, communicative ability etc. Those involved in Green Care services will always be in need of professionaldevelopment related to the user groups associated with the farm. Good routinesshould therefore be developed to assure that farmers receive necessary professionaltraining. Some municipalities enable farmers to participate in their training courses,planning days and seminars as part of the professional follow-up.Quality assurance of the physical environmentAs part of the quality-assurance system, the farm’s physical environment must alsobe looked after. This can include securing the standard of buildings, risk and hazardmanagement strategies, noise protection (machines etc.), dust protection and safetywith regard to pollutants such as chemicals etc. The Working Environment Act places stringent demands on safety measures.Farms with activities classified as Green Care are subject to these regulations.Farmers must therefore contact various authorities (Norwegian Farmers’ Associationfor Occupational Health and Safety, or the Labour Inspection Authority) in order toconfirm which regulations apply to the farm’s new activities. The farm’s insurancecompany should also be included in the discussions about necessary safety measuresrelated to the planned activities on the farm. A central aspect of the Green Care concept is to let users meet ‘real life’ and‘genuine challenges’ on the farm. This will always include a certain risk of smallaccidents. It is important to be conscious of this, without becoming all too hystericalabout safety.

6.
114 L. HAUGAN ET AL.Farm investmentsOften, investments may be necessary in order to comply with specific requirements.Farmers can apply for financial assistance to cover these costs partially. These fundsare allocated via the Agricultural Agreement1 in order to promote farm-basedbusiness development. The funding scheme can provide interest-free loans andsubsidize such investments as the construction, expansion or modernization ofbuildings, or the purchase of fixed assets: renovating and rebuilding houses and farm buildings to comply with the needs of users and pupils; adapting farm buildings, houses and the farmyard area to the needs of the physically disabled; installing sanitary facilities; implementing security measures. Farmers contact the local agricultural authorities for application guidelines andmore information about such financial-assistance schemes. RURAL RESEARCH RELATED TO GREEN CARENumber of farmsIn 2003-04, the Centre for Rural Research conducted a nation-wide survey entitled“Green Care – flexible specialization or traditional supplementary business forNorwegian farmers?” The study showed that there are between 500 and 600 farmsoffering Green Care services in Norway. A similar study in 2002 resulted in a figureof nearly 500. The number of farms providing Green Care thus seems to havestabilized in recent years. However, relatively many farmers stated that they werejust getting started or were considering to start-up in the near future. Also, numerousfarmers reported that they wanted to start providing Green Care services, but so far,without success. There are few data about the reasons for such failure, except for thecases in which farmers state that the local authorities have a negative attitude to suchservices, or do not prioritize their funding. Green Care farms are spread all over thecountry. Another study conducted by the Centre for Rural Research (Rye and Storstad2004) reports that nearly 8% of a representative selection of Norwegian farmerseither provide Green Care services (2.7 %), are in the process of starting up (0.6 %)or are considering the establishment of such services (5.7 %).A diversity of services and target groupsThe most commonly provided service is general education for schoolchildren (141farms), followed by services defined as ‘child welfare’. The third largest targetgroup are persons in need of psychiatric care (120), followed by children withbehavioural problems (103). Farm kindergartens and services for the elderly withdementia are provided by 25 farms (about 8% of the survey group). On several

7.
NORWAY 115farms, various services and target groups are combined. In some cases, youths orpersons with an emotional dysfunction were employed in one of a farm’sprogrammes after having completed individual treatment in another. The gender distribution is somewhat imbalanced. In 35% of provided services,the distribution of men and women is even, in 27% of the services, there are moregirls/women, but boys/men are the majority in 43% of all services offered.Regarding ethnicity of users, Norwegians dominate on most Green Care farms.About 18% of the users, however, are from Asia or Africa.The ‘Green Care farmer’Of those regarding themselves as the ‘main providers’ of farm-based Green Careservices in the survey, 64% are women and 36% are men. The average age of the‘Green Care farmer’ is about 49 years. Many of the farmers in the survey have higher education (42%), and many haveprofessional experience from public services related to the welfare services theyprovide. Many of these farmers are seemingly resourceful persons, showing acertain degree of entrepreneurship within their field. Many Green Care farmers statethat their motives for establishing such services include the wish to be self-employedon their own farms. The mere lack of other employment possibilities is not a mainincentive. Also, 88% report that their spouse or partner is their closest co-worker in theGreen Care enterprise. On many farms, three generations work together.Farm incomeIn 2002 nearly 60% of the Green Care farms had a net income of below € 23,800and operating profits of below € 11,900. Thirteen percent of the farms reported a netincome of more than € 59,000. When asked about expected income developments,43% replied that they expected a higher income, 12% expected a lower income and46% expected about the same income as in the year of reference (2002). About 66%replied that they considered the profitability of Green Care activities to be betterthan that of traditional farm production.Labour inputOf the survey farms, 57% replied that Green Care accounted for less, and 43%replied their services accounted for more than one man-year. Of the latter group offarmers, 27% had a labour input of between one and three man-years, and 7% hadactivities corresponding to five man-years or more. This implies that for some farms,Green Care has developed into a significant business with several employees. Eightypercent of the survey farms had between one and four employees. About two thirdsof the farms had the same number of employees in 2003 as in 2002, whereas 27%had a larger staff in 2003 than in the previous year. Nearly 60% believes that thenumber of employees in the Green Care sector will increase.

8.
116 L. HAUGAN ET AL. Articles from this survey (Fjeldavli and Meistad 2004) can be found athttp://www.bygdeforskning.no/. For a description of three individual Green Carefarms see the Appendices 1 - 3. RESEARCH AT THE AGRICULTURAL UNIVERSITY OF NORWAYAt the Agricultural University of Norway, research on Green Care is part of thetopic ‘Environment, Welfare and Health’ within the University Programme inEnvironmental Research. Research interests include the use of animals, plants,gardens and the landscape to promote health for all humans and provide therapy forpsychiatric patients.Farm-animal-assisted therapyWhile there is much practical experience with letting psychiatric patients work withfarm animals on Green Care farms, there is almost no scientific documentation oneffects on their mental health. In 2001-2002, a pilot study was conducted toinvestigate the feasibility of documenting positive effects of working with cattle orsheep on the mental health of humans with moderate mental diseases: markeddepressions, light schizophrenia and various personality disorders (Berget et al.2004). Validated psychiatric questionnaires were used after 3 hours’ work twice aweek for 10 weeks. Results were encouraging, although 50% of the patients droppedout before the period ended. The most pronounced effect on the completers was amarked reduction in depression. Persons favoured especially the physical contactwith the animals, and nearly all those who completed the intervention period wantedto continue. Farmers and psychiatric primary contacts reported quite positiveexperience with this therapy form. In 2003, a three-year PhD project started, with the title “Green Care with farmanimals in agriculture for humans with mental disorders”. The main objectives ofthe project are to document effects of animal-assisted therapy (AAT) with farmanimals on humans with mental disorders, investigate the relationship between thenature of the human–animal interaction and the observed health effects, and developscientific competence on the topic AAT to be used in education on Green Care inhealth and agricultural studies. The project involves cooperation with psychiatry atthe University of Oslo. Validated questionnaires testing degrees of depression,anxiety, stress coping, self-esteem, quality of life, and social and workingfunctioning are completed before and after the intervention period, and six monthsafter to check for long-term effects. Ethological video studies are performed on thenature and frequency of the human–animal interactions, at the beginning and at theend of the intervention, in order to test for correlations between behaviour towardsanimals and improvement of mental health.

9.
NORWAY 117Plants indoors and in the working environmentAs an integration of plant sciences and environmental psychology, research workfocuses on the effects of plants in the working environment on human health andwell-being (Fjeld et al. 2002). This study will be continued by studies of theinfluence of indoor plants and window view on health outcomes of patients in arehabilitation institution for people with lung and heart diseases. Results may haverelevance also for the indoor and working environment on Green Care farms.Gardens for people with dementiaThe increasing number of people developing dementia has led to an increasinginterest in designing gardens adapted to such persons in connection with institutionalhomes. A guide is developed for helping in the design and selection of specificcomponents of such gardens that may help the users in releasing frustration andgiving moments of enjoyment and remembrance (Grefsrød 2002). Many gardensalso make use of activities related to the farm that elderly people with dementiarelate to, and which become a tool in the communication with the staff and familymembers. EDUCATION RELATED TO GREEN CAREAt the Agricultural University of Norway bachelor-level courses are titled “Natureand quality of life” (PHG112-113, 10-15 ECTS points). The aims of these coursesare to develop a comprehension of the significance of nature for the experiencedhealth and quality of life in humans, and how knowledge from natural sciences andagricultural sciences can be used in prophylactic and therapeutic health work. A lastobjective is to enable the students to work in cross-professional teams with personsfrom health and social care. Teaching includes the significance of nature for humanwell-being and the biophilia hypothesis, relevant health and social concepts, andeffects of forests, plants and animals on the well-being and physical and mentalhealth of humans. Interested students can later develop a master’s thesis project on atopic from this course. Continuing education courses entitled “Green knowledge for use in Green Care”(10 ECTS points) are given to health personnel and farmers interested in GreenCare. Topics are the same as for the bachelor’s courses, but with more focus onpractical projects. Both types of courses are given in collaboration with a university college thatruns programmes in health sciences. FUTURE CHALLENGESEducation, health and welfare services in Norway are a public responsibility. Hence,professional interest groups and certain specialists (e.g., in pedagogy and psychiatry)have been sceptical of services that are not based on professional expertise withinthe public health and social sector. Not all farmers providing Green Care services

10.
118 L. HAUGAN ET AL.have other formal training than agricultural school, and are thus often classified asunskilled labour in the health and welfare sector. This presents a challenge when itcomes to receiving satisfactory pay for the provided services, and in connection withthe quality approval of these services. There are also challenges with regard to general professional and politicalaspects of developing the expertise of Green Care providers and assuring the qualityof their services. Which criteria should be applied to approve the providers of GreenCare and the services themselves? The question of privatization of statutory public services is currently a hotpolitical issue in Norway. One result, or side effect, of this debate is the creation ofseveral new terms and organization models in the public administration sector, suchas exposure to competition, client/supplier model, roles and partnership. The increasingly tighter municipal budgets are another challenge. This must beseen in connection with the increasing number of responsibilities that have beentransferred to the local level. Local governments are thus forced to prioritize theiruse of funds, and cut back on services that are not fixed by law. In many cases, thiswill also affect Green Care services, since many of these are of preventive natureand thus do not belong to those responsibilities which the municipalities have toprovide according to the law. However, it should be noted that preventive measuresare statutory to a certain degree. In such a context, Green Care can only survive as aresult of political negotiations. With the current debate on multifunctional agriculture in mind, these issues alsoinvolve both farmers and the entire agricultural sector. Following the recent WTOnegotiations on agriculture and this summer’s agreement on the liberalization oftrade in food and fibre products, there has once again been considerable media andpublic focus on the role of agriculture and farmers. The above-mentioned challengesfor Green Care thus directly involve the actual justification of Norwegian agricultureand the question of its functions in future society. NOTES1 agreement based on negotiations between the government and the two farmers’unions REFERENCESBerget, B., Ekeberg, Ø. and Braastad, B.O., 2004. Farm animals in therapy for humans with mental disorders. In: Docherty, A., Podberscek, A.L., Whyham, M., et al. eds. People and animals: a timeless relationship: 10th international conference on human–animal interactions, Glasgow, 7-9 October 2004. International Association of Human-Animal Interaction Organisations, Glasgow, 45.Fjeld, T., Veiersted, B., Sandvik, L., et al., 2002. The effect of indoor foliage plants on health and discomfort symptoms among office workers. Indoor and Built Environment, 7 (4), 204-206.Fjeldavli, E. and Meistad, T., 2004. Grønn omsorg og Inn på tunet: frekvensrapport fra en spørreundersøkelse blant gårdbrukere. Norsk Senter for Bygdeforskning, Trondheim. Rapport Bygdeforskning no. R-02/04. [http://www.bygdeforskning.no/Publikasjoner_PDF/ RAPPORT%2002.04.pdf]Grefsrød, E.E., 2002. Eldres liv og hagens visdom: formgivning av terapeutiske hager for personer med demens. Nasjonalt kompetansesenter for aldersdemens, Sem.

12.
120 L. HAUGAN ET AL. APPENDIX 1. FUNDAUNET ENVIRONMENTAL FARM Farm facts Objectives Location: municipality of Meråker, The Fundaunet Environmental North Trøndelag County Farm’s educational programme aims Arable farmland: 40.7 ha + 20 ha fenced- to be an integrated part of the in pasture. teaching activities at Meråker Rough grazing land: 39 ha. School. Crops: Fodder (grass) The curriculum of numerous Livestock: 200 winter-fed sheep and 13 subjects is well adapted to being suckler cows carried out on the farm, including School garden: vegetables, herbs and natural and environmental sciences, flowers home economics, art and crafts, as Schoolroom facilities: 163 m2, including well as physical education. kitchen, classroom, toilets, showers, Farm activities also enable a cloakroom and storage room. practical approach to certain aspects of theoretical classroom work. Byusing the farm as a classroom, it is possible to: link the school’s curriculum to practical farm work help pupils see the connection between theory and practical work enable children to experience personal growth by overcoming practical challenges motivate pupils by giving them responsibility let pupils experience that they can contribute in a working environment experience a working rhythm in step with the changing seasonsA brief historyThe Fundaunet Environmental Farm is based on cooperation between farmer andowner Svenn Tore Ness and agronomist/pedagogue Kjetil Aarbakke. Svenn andKjetil founded a cooperative society, constructed housing for teaching and training,and established a school garden on the farm. Through contact with their localgovernment, they have established cooperation between the farm, school authoritiesand the health and welfare sector. Things have happened fast and are still in aprocess of development. The Green Care services are based on political decisionsand formal agreements. The environmental farm has been well received among pupils, teachers, schoolauthorities, social authorities and local politicians. The farmer and a teacherparticipated in training courses provided by the national project ‘Levande skule’(‘Living school’). The teaching activities on the farm are adapted to the Norwegiancurriculum L97. The focus is on providing a better quality of education than can beachieved in a traditional classroom setting. This was a necessary prerequisite for thegeneral acceptance of the farm’s services. Meråker School has previous experience

13.
NORWAY 121with outdoor schooling and other forms of off-campus education. This made it easierfor both teachers and pupils to utilize the potential of the Fundaunet Farm.Available servicesThe farm is a large, well-run sheep and suckling cow farm. It is located close toMeråker, 3 km from the school, where the farm also has a plot of land and teachingfacilities. Three days a week, the farm is used by the local school, and two days aweek it is used in connection with a sheltered employment service for psychiatricpatients. This presentation focuses mainly on the school-based services. The farm provides an educational programme for classes and groups throughoutthe entire year, but most activities are concentrated in spring and autumn.Specifically adapted teaching of individual pupils can be provided two days a week.The general educational programme consists of: Class teaching (1st to 10th grades) Pupil’s choice School business The fixed, annual class programmes are the backbone of the farm’s activities.The standard programme includes one visit in spring and one in fall for all grades. Acurriculum for each grade has been agreed upon, thus ensuring the continuity of theprogramme in the long run. In addition, there are project-based periods, such as‘pupil’s choice’ in grades five to seven, farming experience, and school businessestablishment in 9th grade.OrganizationThe farm is organized as a cooperative society, which runs the teaching facilities.They have a rental agreement with the municipality, and the owners are employedby the municipality on an hourly basis as teacher and environmental therapist,respectively. The farm’s activities are based on political decisions and formal agreements.One-year agreements regulate the rent, which shall cover capital costs related tobuildings, electricity, insurance, accounting services, telephone and office expenses,land rent, maintenance, operating equipment, furniture and machine rent. The localschool and Fundaunet Environmental Farm cooperate closely.ResultsGeneral feedback and a user-survey among 7th-graders show that the providedservices are very popular among pupils. Teachers also expressed that the farm’sactivities are positive and useful for their classes. The children are able to developthrough the practical farm work they are assigned and their close contact with thefarm animals.

14.
122 L. HAUGAN ET AL.Contact informationKjetil AarbakkeFundaunet miljøgård7530 Meråker - NorwayTel.: +47 71 81 23 75E-mail: kjetil.aarbakke@ meraker.kommune.no APPENDIX 2. VIKUM FARM Objectives Farm facts Location: municipality of Gaular, Sogn After having stayed at Vikum, users og Fjordane County shall be able to live on their own, Arable farmland: 8 ha avoid relapse and thus have a better Rough grazing land: 65 ha quality of life. Crops: Fodder (grass) The services are intended for Livestock: 60 winter-fed sheep persons with drug/alcohol problems Other animals: hens, horses, dogs, cats in need of more intensive care than Housing facilities (for user): separate can be provided by polyclinic house with bedroom, living room, treatment. Users of the Vikum Farm kitchenette, bathroom with a toilet and stay in a safe, drug- and alcohol-free shower. environment with a structured daily rhythm.A brief historyZandra and Kurt started working on establishing their services in 1999. Kurt hasbeen a dry alcoholic for the past 12 years. He also worked as an environmentaltherapist at a youth centre, and has 20 years’ experience as a support person. Both have gone through treatment themselves, so they feel they know a lot aboutwhat it is like to overcome drug/alcohol abuse. “We’ve been thinking about this for years, but things didn’t get going until weread a bit about Green Care”, Zandra explains. Their programme was developed incooperation with local health and welfare workers. Kurt says that it was veryimportant to communicate well with his own municipal authorities and the drug-abuse consultants. These were, and still are, important partners. Their Green Careservices began in August 2000.Available servicesUsers participate in all work related to the farm’s sheep husbandry and forestryactivities. Work varies with the seasons, and can include: Feeding and taking care of animals Assistance during lambing

15.
NORWAY 123 Sheep herding Gathering the sheep in the autumn Shearing Forest work Building maintenanceRecreationThere are lots of things to do for the users in their leisure time, such as hiking,fishing, hunting or skiing. Indoor activities are available in the nearby village.HousingUsers have their own house at their disposal. The house has a bedroom, living room,kitchenette, bathroom with a toilet and shower. A PC and a TV are also available.Housing is based on self-catering, thus strengthening the users’ ability to beresponsible for their own lives.OrganizationUsers live and are under supervision at Vikum full-time. Zandra and Kurt areaccessible 24 hours a day. There is usually only one user on the farm at a time, buthaving several users together has also worked well. The duration of the stay varies,from several weeks to several years. This depends on how the stay at Vikum isintegrated with other treatment. Some users come to Vikum prior to moving to otherinstitutions, whereas others come as part of a post-treatment programme. Most usersstay at Vikum during their entire treatment period. It is important to clarify the responsibilities and roles of farmers and users. Anagreement is made for each user, in cooperation with the municipal primary andsecondary services. Users shall be under continuous observation of the health andwelfare system. The treatment scheme must be outlined in a contract, which is to besigned by the user and the provider of the service. The contract must containdetailed information about: Design and duration of the stay Working hours Work description Improvement of the user’s drug/alcohol problem Use of medicines Timing of therapy Visits Leave of absence Leisure time Consequences of relapse during the stay

16.
124 L. HAUGAN ET AL. An agreement is also to be made between Vikum and the buyer of the service,i.e., the state. The services can also be provided for users from other counties.Zandra and Kurt are self-employed and charge a daily rate in those periods whenthey have users on the farm.Quality assuranceThe service is based on cooperation between the psychiatric clinic, the user’s socialwelfare office and Vikum Farm. Admission is based on a written application sent tothe farm by the welfare office of the user’s place of residence. The drug-abuseconsultant is also involved, and decides on which patients to prioritize. The drug-abuse consultants approve the treatment programme at Vikum, and are responsiblefor quality assurance. The head physician of the psychiatric clinic, however, isgenerally responsible for the treatment. Zandra and Kurt also receive support fromthe local psychiatric nurse.ResultsThe providers of the services at Vikum have only received positive feedback fromtheir users and the drug-abuse authorities. Users appreciate working with animalsand the close contact with nature. The main challenge for many users is the periodafter having completed the stay at Vikum. Some have a relapse, and thus have amuch longer road ahead of them to overcome their drug abuse.Contact informationZandra and Kurt VikumVikum6978 Viksdalen - NorwayTel.: +47 57 71 69 24E-mail: zanvik@c2i.net APPENDIX 3. SANDE BRUKAdmission criteria Dementia diagnosis, early stage. Cognitive deficit also relevant Assessment of functional status Users must be able to walk, also stairs Users should be between 50 and 70 years; older persons can also be admitted, mobility and health conditions allowing Trial period of 2-3 days prior to admission If a user is injured, or his/her condition changes and more intensive care becomes necessary, other, suitable services must be provided

17.
NORWAY 125Users from other municipalitiesThe service is provided as long as a user fulfils the necessary requirements. Whenthese are no longer met, the contract is cancelled with two weeks notice. The user’smunicipality of residence is responsible for the further treatment of the personThe projectThe day-care service is based on cooperation between the municipality of Horten,the Vestfold County Governor and the Norwegian Centre for Dementia Research.The project was initiated in 2002, and lasts until 2005. The focus is on the preventive effect of such systematic measures for the usergroup in question. The project will also evaluate the organization of the servicewithin the inter-municipal cooperation in Vestfold County.Agriculture and dementia careAgriculture in Norway is in a phase of transition, and as a result there are nowcommon interests between the farming community and elderly care, with specificfocus on dementia patients. The services are designed to meet the needs of middle-aged persons (about 50-70 years old) in early stages of dementia. The day careservices include: Morning coffee, small talk, singing Joint planning of the day’s programme Various social and physical activities Lunch Day care service is adapted to the needs of the users. Day-to-day activitiesdepend significantly on the interests and functional status of the users. There is adaily user charge of NOK 59. During the project period, transport is free.Family and preventionThe day care service at Sande Bruk aims to maintain an open dialogue betweenstaff, users and their family members. The service also intends to enable relatives tohave some time off from their caring responsibilities. A dementia diagnosis leads to many necessary changes in life. In numerousways, the illness also affects one’s family and social network. Research andexperience related to dementia underline the need of an open approach to the illness.Individually designed activities help patients to master their daily lives and increasetheir well-being. Day-care services for dementia patients have been shown to have a beneficialeffect on the development of the illness after a relatively short time. Another benefitis providing some relief to their families. This preventive effect may enable patientsto have a better quality of life at home. The development of dementia can be sloweddown by as much as a year and a half.